“Creating a healthier Central Oregon.”

The Central Oregon Health Council Board of Directors reserves the right to transition into an executive session at

any point during the Board meeting.

Council

▪ Rick Treleaven, Chair, LCSW Executive Director BestCare Treatment Services, Inc.

▪ Linda Johnson, Vice Chair, Community Representative

▪ Patti Adair, Commissioner, Deschutes County

▪ Eric Alexander, CEO Partners in Care

▪ Paul Andrews, Ed.D Superintendent High Desert ESD

▪ Tammy Baney,

Executive Director, Central Oregon Intergovernmental Council

▪ Seth Crawford Commissioner, Crook County

▪ Megan Haase, FNP CEO, Mosaic Medical

▪ Linda McCoy Community Representative

▪ Ellie Naderi President, Advantage Dental

▪ Divya Sharma, MD Central Oregon IPA Representative

▪ Kelly Simmelink, Commissioner, Jefferson County

▪ Justin Sivill Executive Director, Summit BMC

▪ Dan Stevens Executive VP, PacificSource

▪ Jenn Welander (Interim) CFO, St. Charles Health System

The Environmental Center, Audobon Room

16 NW Kansas Ave, Bend January 9, 2020

Dial In – See calendar invite for Zoom details to join from a computer

Phones: 1(669) 900-6833, Code: 542240567#

Welcome – Rick Treleaven

12:30 – 12:35 Introductions

12:35 – 12:40 Public Comment

12:40 – 1:00 Celebrate Tammy – Rick Treleaven/All

1:00 – 1:05 Approve Consent Agenda………………………. vote

1:05 – 1:10 Patient Story – Patti Adair…...…...…………….. information

Long-Term Systemic Change 1:10 – 2:10 Governance Committee – Linda Johnson............ information Attachments

Governance 2:10 – 2:20 Finance Committee – Megan Haase……........... vote Attachment: Motion 2:20 – 2:40 CCO 2020 Metrics – Leslie Neugebauer……...... discussion Attachment: Proposed Metrics

RHA/RHIP 2:40 – 3:10 Vote on Final Board Fund Distribution – Rick Treleaven…………..................................... vote Separate cover: Proposals/presentations 3:10 – 3:30 2020-2023 RHIP Release – Rebeckah Berry …... information

Consent Agenda

• December 2019 Board Minutes

• November 2019 COHC Financials

• CCO Dashboard Written Reports

• Executive Director Update

• December 2019 CAC Minutes

• Funded Grant Reports

MINUTES OF A MEETING OF

THE BOARD OF DIRECTORS OF

CENTRAL OREGON HEALTH COUNCIL

HELD AT HIGH DESERT ESD

2804 SW 6TH STREET, REDMOND

December 12, 2019

A meeting of the Board of Directors (the “Board”) of Central Oregon Health Council, an

Oregon public benefit corporation (the “Corporation”), was held at 12:30 p.m. Pacific Standard

Time on December 12, 2019, at the High Desert Education Service District, in Redmond, Oregon.

Notice of the meeting had been sent to all members of the Board in accordance with the

Corporation’s bylaws.

Directors Present: Tammy Baney, Chair

Patti Adair

Eric Alexander

Paul Andrews, Ed.D

Linda Johnson

Linda McCoy

Ellie Naderi

Divya Sharma, MD

Kelly Simmelink

Justin Sivill

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Dan Stevens

Rick Treleaven

Jenn Welander (dial-in)

Directors Absent: Seth Crawford

Megan Haase, FNP

Guests Present: MaCayla Arsenault, Central Oregon Health Council

Scott Aycock, Central Oregon Intergovernmental Council

Rebeckah Berry, Central Oregon Health Council

Gwen Jones, Central Oregon Health Council

Cathy Kaufmann, Tenfold Health

Katie McClure, TRACEs

Donna Mills, Central Oregon Health Council

Leslie Neugebauer, PacificSource

Kelsey Seymour, Central Oregon Health Council

Ms. Baney served as Chair of the meeting and Ms. Seymour served as Secretary of the meeting. Ms.

Baney called the meeting to order and announced that a quorum of directors was present and the

meeting, having been duly convened in accordance with the Corporation’s bylaws, was ready to

proceed with business.

WELCOME

Ms. Baney welcomed all attendees to the meeting; introductions were made around the room and on

the phone.

PUBLIC COMMENT

Ms. Baney welcomed public comment. Ms. Mills announced that the Finance Committee has asked

CAP Steering to fulfill the Board’s request regarding input on the CCO Dashboard.

3

CONSENT AGENDA

The consent agenda included the November minutes, the CCO Dashboard, and COHC Financials

for October.

MOTION TO APPROVE: Mr. Stevens motioned to approve the consent agenda; Ms. Johnson

seconded. The motion was approved.

PATIENT STORY

Mr. Stevens shared the initial results of public equity forums PacificSource has conducted over the

last several months. He quoted several patients regarding interpretation services. He invited the Board

to participate in a listening session next week.

ACTION: Ms. Seymour will send the listening session event information to the Board.

GOVERNANCE COMMITTEE

Ms. Johnson reminded the Board that at the previous meeting not many members were able to

participate in the final discussion regarding the scope of the COHC. She invited Mr. Stevens to share

an update on Senate Bill 889 with the Board on behalf of Ms. Welander who wrote it and who sits on

the implementation committee. Mr. Stevens explained that SB 889 is the State’s mechanism for

curbing rising costs of health care across all lines of business.

Ms. Kaufmann introduced herself, noting she was invited to facilitate today’s discussion regarding the

future state of the COHC. She led the Board through a discussion about the positive and negative

aspects of expanding the focus of the COHC.

After much discussion Ms. Kaufmann concluded that the COHC Board members need to build

explicit agreements with one another, starting with values and agreements on direction. She agreed to

summarize her notes for future reflection.

ACTION: Ms. Kaufmann will send Ms. Mills her notes from this discussion.

COHC BOARD OFFICERS

Ms. Baney announced that she is excited to support the next phase of leadership as she moves out of

her elected seat as Chair. She thanked them for the opportunity to serve for the past ten years.

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Ms. Johnson announced that the nominations for 2020 Board officers are Mr. Treleaven as Chair and

Ms. Johnson as Vice Chair. She confirmed that the Governance Committee supports these choices.

MOTION TO APPROVE: Mr. Sivill motioned to confirm Mr. Treleaven as Chair; Ms. Naderi

seconded. All were in favor, the motion passed unanimously.

MOTION TO APPROVE: Mr. Sivill motioned to confirm Ms. Johnson as Vice Chair; Mr. Treleaven

seconded. All were in favor, the motion passed unanimously.

REGIONAL HOUSING NEEDS ASSESSMENT (RHNA)

Mr. Aycock shared the results of the RHNA, completed in May of 2019. He noted that no baseline

data tool for tracking the homeless population exists. He added that housing vouchers are in short

supply, and only one-third of those awarded are able to be used within the 90-day window.

CCO 2019 METRIC REPORT OUT

Ms. Neugebauer shared that 2019 QIM performance will likely yield a 70% payout again. She noted

that PacificSource is on track with the 2020 projects. She noted that PacificSource has hired 50-60

people in the last few months in preparation for their expansion into Marion/Polk and Lane Counties.

TRACES PROPOSAL

Ms. McClure proposed a $1.3M investment from the COHC Board of Directors to fund two

additional years of the TRACEs movement. She reviewed the roots of trauma and the financial impact

it has on a community. She outlined the value that TRACEs has already added to the Central Oregon

community and explained the need for the full 10-year plan to be executed.

Ms. Baney reminded the Board that they will be voting to distribute their remaining funds at the

January meeting between the TRACEs proposal and the two others from the last two months.

ADJOURNMENT

There being no further business to come before the Board, the meeting was adjourned at 3:28 pm

Pacific Standard Time.

Respectfully submitted,

_________________________

Kelsey Seymour, Secretary

5

Central Oregon Health Council

Statement of Financial Position YTD 11.30.19

ASSETS General Fund

Total Checking/Savings 19,963,269$

COPA - Security Deposit 1,997

TOTAL ASSETS 19,965,266$

LIABILITIES & EQUITY

Accounts Payable 55,985$

Payroll Payable (PTO Accrual) 29,193

85,178

Grants Payable 3,537,518

3,622,696

16,342,570 TOTAL LIABILITIES & EQUITY 19,965,266$

Revenue Actual Budget % Variance

Operating Revenue 813,682$ 779,167$ 4%

Community Impact Funds 2,376,973 2,291,667 4%

Grants 184,344 269,309 -32%

2018 Shared Savings (old JMA) 7,535,282 - - Shared Savings not budgeted

Interest income 203,652 137,500 48%

Total Revenue 11,113,933 3,477,643 220%

Expenses

Operating Expense 999,979 1,069,361 6%

Community Impact Funds* 5,810,878 2,291,667 -154% ** Total Expenses 6,810,857 3,361,028 -103%

Net Income 4,303,076$ 116,615$ 3590%

* Community Impact Funds - Top 4 funded 2019

Culture of Care $1,476,620

Perinatal Care Continuum 899,400

NICH 350,000

Developmental Pathways 299,646 All other 2,785,212 -

5,810,878$

**Variance is due to timing of Community Impact Funds revenue and

distribution of funds through Grants in different years.

**********The Finance Committee found no material budget variances on the PSCS November 30, 2019 Financials******

6

FOCUS POPULATION: SPMIMembers with Severe & Persistent Mental Illness

Snapshot of Currently Enrolled Members with SPMI*

CurrentMembersw/SPMI

2,168Members

392Children< 18 yrs

34Avg Age

% Depression

% Substance Abuse

% Diabetes

% Hypertension

% Pre-Diabetes

% Asthma

% Obesity

% Hepatitis C

% COPD

% Chronic Liver Disease

54%

20%

6%

5%

4%

4%

4%

2%

2%

1%

Top Co-Morbidities

*This analysis does not include major depression as a qualifying SPMI diagnosis.

MEMBERSHIPAverage Membership by Rate Group

2016 2017 2018 2019

ABAD/OAA w/ & w/oMedicare

ACA Adults

CAF Children

PLM, TANF, and CHIPChildren 0 - 18

Poverty Level MedicalAdults

Special Needs RateGroup / BCCP* (in 2017)

Temporary Assistance toNeedy Families (AdultsOnly)

4037(8.0%)

4110(8.7%)

4213(8.8%)

4734(9.7%)

20645(41.0%)

18109(38.3%)

18118(38.0%)

18196(37.5%)

675(1.3%)

752(1.6%)

776(1.6%)

771(1.6%)

20572(40.9%)

20111(42.5%)

20158(42.3%)

20144(41.5%)

739(1.5%)

594(1.3%)

529(1.1%)

463(1.0%)

31(0.1%)

20(0.0%)

16(0.0%)

17(0.0%)

3594(7.1%)

3637(7.7%)

3810(8.0%)

4254(8.8%)

Central OR CCOCoordinated Care Organization (Medicaid) 1/3/2020

ACCESS & UTILIZATION(1/2017 to 12/2019, paid thru 12/2019; no completion factor applied)

RATE .Per Member .Per Year .

BehavioralHealth (BH)

201720182019 YTD

Dental 201720182019 YTD

PrimaryCare (PCP)

201720182019 YTD

2.8

3.63.3

1.01.11.1

2.32.42.5

% OF .MEMBERS.(Unique Mems)

BehavioralHealth (BH)

201720182019 YTD

Dental 201720182019 YTD

PrimaryCare (PCP)

201720182019 YTD

Any Claim 201720182019 YTD

22%21%18%

34%37%35%

58%61%59%

79%82%79%

06/1812/1806/19

60 50

SUD RES & DETOX# MEMBERS

# Memberssince 1/2018:

05/1810/1803/1908/19

11,1718,200

NEMT#SERVICES (ALL TYPES)

6,236NEMT

768SUD RES

COST OF CARE

Actual PMPMDifference fromBudget

Medical Excl. Cap

12/18 $131.47 ($13.76)

11/19 $166.68 ($27.41)

Dental 12/18 $25.85 ($0.99)

11/19 $26.76 ($1.28)

Pharmacy 12/18 $64.15 $4.66

11/19 $65.48 $3.63

Capitated BH, PCP, Hosp

12/18 $167.56 ($0.48)

11/19 $152.43 $11.29

TOTAL EXPENSES

12/18 $403.13 ($12.94)

11/19 $430.94 ($14.61)

02/16

05/16

08/16

11/16

02/17

05/17

08/17

11/17

02/18

05/18

08/18

11/18

02/19

05/19

08/19

11/19

95%

100% 97.0%

AvgAvg

Expenses & Claims Over Revenue (YTD)

MEMBERCOUNTS

DEC2019

49,054Members

20,272 children

28,782 adults09/1508/1607/1706/1805/19

52,585 49,054 AVG MEMBERSHIP (YEAR TO DATE FROM FINANCE)

48,89148,704 ACTUAL

BUDGET

= Budget

7

Avg

BH

Cap

Den

Detox

General AdministrativeExpense (G&A)

Hosp

Medical Claims Expense

Mems

MH/CD

Misc

MM

NEMT

Net Income

PCP

PMPM

Premium Taxes & OMIP

QIM

Rx

SPMI

SUD

SUD RES

Total Revenue

Underwriting Income

Utilization

YTD Year to date. For this dashboard, Financial YTD is based on the calendar year beginning January 1st.

Use of a good or service

Underwriting Income combined with results of activities not directly related to continuing operations, on an after tax basis.

Substance Use Disorder Residential Treatment

Substance Use Disorder

State mandated taxes collected on a per member per month (PMPM) or % of premium basis.

Severe and persistent mental illness. Members of all ages are included if diagnosed at any time with a condition outlined by OHAand USDOJ as SPMI. This includes certain depression diagnoses. Identification of members based on Medicaid CCO claims.

Quality Incentive Measure program by Oregon Health Authority for Coordinated Care Organizations.

Primary Care Provider

Prescription

Premiums collected for insurance, net of HRA costs. Premiums for Oregon Health Plan recipients are received from the state ofOregon

Per member per month

Non-Emergent Medical Transport

Miscellaneous Services not otherwise categorized.

Mental Health / Chemical Dependency

Members

Member Months. One member month = one person enrolled for a whole month. If a person is enrolled for an entire year, that isequivalent to 12 member months. If a person is enrolled for 2 out of 4 weeks in the month, that is 0.5 member months.

Income after Operations and other activities not directly related to continuing operations.

Hospital (when listed under "Capitated" label, only includes capitated inpatient services)

Expenses related to the administration of the plan including, but not limited to, staff salary and benefits, telephone, depreciation,software licenses, utilities, compliance, etc.

Detoxification Services. When expressed with Substance Use Disorder Residential (SUD RES) these are detoxification servicesprovided in the residential setting.

Dental Services

Claims-related expenses, including capitation, pharmacy, disease management and network fees, pharmacy rebates (if applicable),health services expenses and IBNR (incurred but not received).

Capitation

Behavioral Health (mental health, substance abuse and addictions)

Average

DEFINITIONS

NOTE: As of 4/2017, all financial PMPMs and cost bucketing comes from the Finance Department and no longer uses Actuarial bucketing. This means thatcosts, revenues and expenses are all presented on an paid date basis, regardless of what year they were incurred.

*BCCP & SPECIAL NEEDS RATE GROUP NOTE: As of 2017, Special Needs Rate Group (Rate Group X) is no longer a grouping by OHA. Starting in 2017, OHAused Rate Group X to classify Breast Cancer and Cervical Cancer Program members (BCCP).

8

Governance Committee Agenda Item: Please find our course of action as outlined by the Governance Committee below: Linda J.

• Review Cathy’s notes from December Board Meeting and confirm/deny that thoughts/discussions were captured accurately

• Confirm that the Mission and Vision are solid per the last Board meeting: o Mission: To serve as a highly effective community governance board for

the region’s Coordinated Care Organization (CCO); and align and influence agencies, caregivers, residents, and policy makers.

o Vision: Creating a Healthier Central Oregon

COHC Staff • Facilitated discussion reviewing and defining current Values/Core Intentions to

determine core set of values. Linda J.

• Present Governance Committee proposed timeline for retreat and working towards COHC Ends and Future State development.

Questions, coming in February, to keep in mind as we move through this exercise:

• What do we provide? • To whom? • At what cost?

9

COHC Board: Dec. 12, 2019 Governance Discussion Summary Facilitated by Cathy Kaufmann, Tenfold

Background

• The Board has been discussing the future mission and role of COHC over the past few months.

o There are arguments for expanding the mission to focus on transforming health care delivery and population health for all people in the region, not just the Medicaid population.

• In the March Board retreat, Board members expressed an interest in an expanded focus. o However, some Board members were not present for that discussion and new

members have come on since that retreat. • The Governance Committee decided to bring this discussion back to the Board in order

to provide a “level setting” for new members, as well as to come to agreements about next steps.

Discussion

• Board members were asked to weigh in on the reasons for wanting an expanded focus, as well as their concerns.

• Members identified the following reasons for broadening COHC’s focus: o It’s important to keep pushing and to be aspirational o If not COHC, then who? COHC is the only organization in the region that could

play this role o The Board has the expertise and representation to be able to support a broader

purpose o People move on and off Medicaid all the time. It makes sense to support

transformation of the other payers they touch. o COHC should try to spread successes to date beyond Medicaid for benefit of the

region. o The original CCO vision always included some component of population health

that is not limited to just Medicaid. Some of COHC’s existing program does serve a broader population already.

• Board members then identified reasons why COHC’s mission should not be expanded beyond Medicaid.

o Some members have concerns about the economic model for Medicaid and do not believe this model can be pushed to other payers at this stage.

10

o In general, Board members agreed there is still a significant amount of work to do with Medicaid and COHC is not ready to focus efforts beyond Medicaid at this stage.

o There was also agreement that the existing mission statement is sufficient.

• In addition, Board members noted: o COHC needs increased clarity around its purpose, regardless of whether or not

the mission is broadened. o There is fragmentation between COHC governance and the CCO contract. o COHC struggles with hard conversations around payment and financing. o Board members expressed the need for the board to make concrete agreements

and stick to them. The discussion of COHC’s mission has continued over a number of months and needs to come to resolution.

o There is a lack of clarity over how COHC conducts its work – is it an operational board, focused on oversight of the CCO contract, or is it a strategic board?

o Board members identified three levers for COHC’s work: 1. Contracts: CCO Contract and contracts with providers 2. QIMS 3. RHA/RHIP (and other project funds)

o There was general agreement that contracts are siloed from the QIMS and RHA/RHIP.

o The Board would like to see better mechanisms for financial sustainability for the projects they fund.

Agreements

• Board members want to keep COHC’s current mission and purpose but increase the focus and effectiveness of their efforts.

• The Board is interested in exploring ways to better leverage the QIMS and the RHA/RHIP more effectively with the contracts.

Next Steps

• The Tenfold team will work with the Governance Committee to develop next steps.

11

12

Finance Committee Motion: “Subject to PacificSource adjusting the budget to achieve the contractual requirements of the JMA, we motion to approve the CCO 2020 budget as presented, contingent that the Board ask for the establishment of a working committee to evaluate understand and manage the cost curve on behalf of the COHC during 2020.”

CentralOregonHealthCouncilExecutiveDirector’sUpdate

January9,2020• FacilitatePEPmeeting• FacilitateFinancemeeting• Multiplestakeholder/communitymeetings• SteeringcommitteeforTRACESwork(UnitedWay)• ELHubasex-officiomember• ElHubInvestmentSteeringCommittee• CentralOregonSuicidePreventionAllianceLeadership• COHIEBoardMember–HIE&SocialServicesplatform• SystemofCareExecutiveTeammember• Grantsoftwaremanagement• RHAtoRHIPwork2020-2023• ManagingPDO,OHAandOCRgrantfunds• ManagingOABHIcontract• CCO2.0alignmentandsupportandtraining• ManagingQIMAdolescentWellChecksub-group• ManagingQIMEDsub-group• Grantapplicationsrevision• BoardGovernanceCommitteesupport• AssistingnewHealthCouncils• ProjectplanforBoardGovernancework(ENDS)• Websiteredesign• ChildcareAcceleratorsteeringcommittee• Strategicplanworkwithstafffor2020RHIPlaunch• PTO12.23.19–12.31.19• SB648review(holdinguntillongsession)Comingup:

• LaunchnewRHIPworkgroups

13

COHC Community Advisory Council High Desert ESD, Community Room

Redmond, Oregon December 12, 2019

Present: Linda McCoy, Chair, Consumer Representative Larry Kogosvek, Vice Chair, Consumer Representative Michael Baker, Jefferson County Health (Ex-Officio) Linda Johnson, Community Representative Elaine Knobbs-Seasholtz, Mosaic Medical Ken Wilhelm, United Way of Deschutes County Cris Woodard, Consumer Representative Absent: Jolene Greene, Consumer Representative Tom Kuhn, Deschutes County Health Services (Ex-Officio) Brad Porterfield, Consumer Representative Vicky Ryan, Crook County Health Department (Ex-Officio) Elizabeth Schmitt, Consumer Representative Others Present: MaCayla Arsenault, Central Oregon Health Council Patti Gaskins, Bend Treatment Center Miguel Herrada Donna Mills, Central Oregon Health Council Leslie Neugebauer, PacificSource Kelsey Seymour, Central Oregon Health Council Molly Taroli, PacificSource Maria Waters, Oregon Health Authority Wendi Worthington, COCC Introductions

• Introductions were made and Linda McCoy welcomed all attendees. Public Comment

• Linda McCoy welcomed public comment. No public comment was made

14

Announcements • Linda McCoy shared that Bruce Abernethy is resigning from the CAC. She announced

that Cyndi Kallstrom will be retiring in January, and the new Innovator Agent for CentralOregon, Dustin Zimmerman, currently works with PacificSource in the Gorge.

Approval of the Minutes • Linda McCoy asked for approval of the draft minutes. Ken Wilhelm motioned for

approval, and Linda Johnson seconded. All were in favor; the minutes were approvedunanimously.

Community Lens: Assistor Sharing • Patti Gaskins explained that Bend Treatment Center (BTC) is a Medication Assisted

Treatment (MAT) center focused on opioid use disorder. She shared that clients come inregularly for a dose of suboxone or methodone, requiring them to make frequentappearances at the clinic depending on how far along they are in their treatment.

• Patti shared that the largest issue for clients is regarding transportation availability,especially for the homeless. She noted that some drivers rush clients out of theirappointments by calling them while they’re in counseling and insisting they leave. Sheadded that some client’s rides are being cancelled but the client isn’t notified until theday of.

• Patti noted that switching between CCOs is a long time for clients in need of immediateservices. Maria Waters shared that OHA is aware of this issue and they are working onit.

• Molly Taroli invited Patti to participate in the Non-Emergent Medical Transportation(NEMT) meetings.

PacificSource: Healthy Equity • Miguel Herrada shared OHA’s definition of Health Equity. He noted that listening

sessions have been conducted around the region, and a plan for health equity should besubmitted in March.

• Miguel asked what CAC members would change to improve equitable access to CCOservices. Suggestions included eligibility regardless of documentation, eligibility forhigher income levels, better interpreter access for specialists, better coordinationbetween Medicaid and Medicare.

Health Workforce Development • Wendi Worthington discussed the workforce development opportunities at COCC for

health care, including certificates and associates degrees. She noted that enrollment inthese programs is low despite the workforce shortage.

• Cris Woodard and Larry Kogosvek attested to the quality of COCC’s programs throughtheir personal experiences.

15

• The group discussed the greater need for these programs in Redmond, Prineville and Madras and the openings for practicum in the more rural clinics.

Community Benefit Initiative & CAC’s Responsibility

• MaCayla shared that the CAC will receive approximately $250,000 annually to allocate toward Social Determinants of Health (SDOH). She clarified the restrictions on the funds, and explained that these monies are separate from the RHIP workgroups, however, the money is being extracted from what would normally have been allocated to them. She noted the CAC will be taken through an A3 process to determine where to invest the money.

CCO Updates • Non-Emergent Medical Transportation (NEMT)

o Molly shared that Gridworks will not receive the contract from PacificSource, and that the current contract with the Cascades East Ride Center (CERC) will be extended through March 31st until another vendor can be contracted.

• Transformation Quality Strategy (TQS) o Molly shared that MaCayla will be included in the TQS Steering Committee

quarterly along with a member of the CAC.

Regional Health Improvement Plan Update • MaCayla announced that the 2020-2023 RHIP has been completed and is being

developed at the designer. She noted it will be released at the next meeting.

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